Nervenheilkunde 2020; 39(05): 305-313
DOI: 10.1055/a-1100-4768
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Tiefe Hirnstimulation als Therapieoption für das Tourette-Syndrom

Deep brain stimulation as a treatment option for Tourette syndrome
Ana Luísa de A. Marcelino
1   Sektion für Bewegungsstörungen und Neuromodulation, Klinik für Neurologie, Charité Campus Mitte, Charité – Universitätsmedizin Berlin
,
Tina Mainka
1   Sektion für Bewegungsstörungen und Neuromodulation, Klinik für Neurologie, Charité Campus Mitte, Charité – Universitätsmedizin Berlin
2   Berlin Institute of Health (BIH), Berlin
,
Christos Ganos
1   Sektion für Bewegungsstörungen und Neuromodulation, Klinik für Neurologie, Charité Campus Mitte, Charité – Universitätsmedizin Berlin
,
Andrea A. Kühn
1   Sektion für Bewegungsstörungen und Neuromodulation, Klinik für Neurologie, Charité Campus Mitte, Charité – Universitätsmedizin Berlin
3   Berlin School of Mind and Brain, Charité – Universitätsmedizin Berlin
4   NeuroCure, Charité – Universitätsmedizin Berlin
5   DZNE, Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
05 May 2020 (online)

ZUSAMMENFASSUNG

Das Tourette-Syndrom (TS) ist eine neuropsychiatrische Erkrankung, die durch das Auftreten motorischer und vokaler Tics charakterisiert ist. Bei einem geringen Teil der Patienten sind die Symptome durch medikamentöse und behaviorale Therapie nicht ausreichend gut behandelbar. Hier kann eine Therapieeskalation erwogen werden. Die tiefe Hirnstimulation (THS) ist ein invasives Therapieverfahren, das bei bestimmten Bewegungsstörungen etabliert ist und für die Therapie des TS zunehmend an Bedeutung gewinnt. Der folgende Artikel fasst die aktuelle Evidenz zur Anwendung der THS beim TS zusammen. Die meiste Erfahrung liegt für die thalamische und pallidale Stimulation vor, wobei bisher keines der Zielgebiete deutlich überlegen war. Die Studienlage zeigt eine durchschnittliche Reduktion der Tic-Schwere unter THS von bis zu 40 % nach einem Jahr. Inwiefern die THS zu einer Besserung der oft begleitenden psychiatrischen Komorbiditäten führt, bleibt aufgrund der geringen Fallzahlen unsicher. Beim TS ist eine erhöhte Anzahl an postoperativen Infektionen aufgefallen, deren Ursache nicht geklärt wurde. Zusammenfassend zeigen die Studien, dass eine THS beim TS eine sichere Therapieoption zur Behandlung schwerer medikamentös nicht behandelbarer Tics darstellt. Die THS sollte an Zentren durchgeführt werden, in denen Expertise sowohl in der Behandlung von Tics als auch für THS vorliegt.

ABSTRACT

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the presence of motor and vocal tics. In a subset of patients pharmacological and behavioural therapy are not effective and deep brain stimulation should be considered. Deep brain stimulation (DBS) is an invasive therapy established for specific movement disorders that has been gaining relevance in the treatment of TS. This article aims to give an overview about the use of DBS in TS. Recent evidence reports on an average reduction in tic severity over 40 % after one year of DBS, but long-term data on efficacy are sparce. It remains to be elucidated if psychiatric comorbidities of TS improve with DBS. Even though there is most experience with thalamic and pallidal targets for DBS in TS, optimal target selection remains unclear. Stimulation associated side effects depend on the anatomical target. Hardware infections are more common adverse events in patients with TS than in other indications for DBS. Thus, DBS should be considered for patients with treatment-resistant TS that suffer from severe tics. Importantly, in cases evaluated for DBS, tics should be the predominant source of disability. The operation should be performed in centres with long-standing experience both in the treatment of tics and DBS.

 
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